Tami Jones

How interoperability allows health information exchanges to thrive

August 1, 2021

What will we gain from interoperability? How far are we on the interoperability journey? Newcomer or expert, we all need to join the conversation. Let’s start off by defining some areas so we can discuss the subject. 

What does health information exchange (HIE) mean? 

If you don’t come from a background within healthcare IT, it is possible that you have never heard the term health information exchange. The term has two meanings.  

The verb health information exchange (HIE) is the ability to move healthcare and/or clinical information electronically across and between healthcare information systems within a hospital, community, or region.  

The term is also a noun: HIE also refers to the health information organizations within the United States (HIO) that facilitate the exchange e.g., hospital, state entity, or non-profit organization. The goal of HIE organizations is to enable safer, efficient, effective, and equitable patient-centered care through information sharing. 

What does interoperability mean? 

According to The Healthcare Information and Management Systems Society (HIMSS) article Interoperability in Healthcare, interoperability can be defined as “the ability of different information systems, devices, and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional, and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally.” 

There are four levels to interoperability: 

  • Level 1 is referred to as the foundation and creates the inter-connectivity needs for systems or applications to ensure secure data exchange. 
  • Level 2 is the structural aspect e.g. The format, composition, and organization of data exchange. It also includes data field level for clarification. 
  • Level 3 is the semantic level and refers to the data’s codifications, models, elements, value sets, coding vocabularies etc. 
  • Level 4 is the organizational level and contains governance, policies, legal aspects, and organizational aspects to ensure secure, seamless and effective communication.  

Health information exchange and interoperability 

Level one was laid by healthcare organizations using various electronic data sources that need to be capable of communicating with one another. For level two of interoperability, the United States and other countries are looking to standards such as Fast Healthcare Interoperability Resources (FHIR) or Open EHR as a structural format.  

Interoperability for health information exchange is facing huge changes due to recent regulations like the 21st Century Cures Act and guidelines from The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS). Together they are enforcing policies and improving regulations for the industry pushing towards an improved Interoperability with common standards such as FHIR.   

Level one (foundational need) and level two (structural format) have been clearly defined by the industry and government requirements.  

Moving onto the third level of interoperability for HIEs, semantic interoperability can seem more complex, convoluted, and less defined on how to achieve it. Semantics are an important part of interoperability because “achieving interoperable data would be less effective if there is no semantics in the communication components which can only be achieved when the process is interoperable. Semantic data interoperability means understanding of the data communicated between sender and receiver in such a way that the receiver easily interprets the sender intention of sending the data and properly responds.”1 

Without the understanding of the data sent (semantics), the receiver cannot properly respond to the information received.  

But how do you get there?  

Semantic interoperability for HIEs can be achieved through healthcare data management. There are tools, such as Rhapsody Semantic, that address the data codifications, models, elements, value sets, coding vocabularies etc. Tools like Semantic can standardize and normalize the data to allow for the sender and the receiver to understand and use the data being exchanged. 

The value of interoperability for HIEs 

Achieving semantic interoperability is of great value to HIEs and healthcare organizations. The value of fully standardized electronic health care information exchange and interoperability could yield a net value of $77.8 billion per year once fully implemented (achieving level 4).  Semantic interoperability is a truly important area in the levels of interoperability that ensures efficiency and cost savings. 

According to Eric Pan et.al in the article The Value of Health Care Information Exchange and Interoperability reaching Level 3, the semantic level of interoperability, could produce an annual national benefit of approximately $44.1 billion. That value is comprised semantic interoperability cost savings in the following areas: 

  • $18.8 Billion – hospital-based outpatient clinicians and external laboratories 
  • $14.4 billion – imaging tests done at external radiology centers 
  • $2.66 billion – outpatient providers and pharmacies 
  • $8.11 billion – chart requests and referrals 
  • $107 million – disease reporting 

Achieving semantic interoperability in the above areas also means that patients will not have to repeat testing and be exposed to unnecessary x-ray, blood draws, or potentially harmful drug interactions.  

Chart requests and referrals can be done easily, which saves time and resources for both the patient and the healthcare organization.  

Also, disease reporting and vital statistics could provide earlier recognition of potential disease outbreaks, which proved to be important during the COVID-19 outbreak. The value of semantic interoperability for HIEs and healthcare organizations has a dollar amount attached to it, but it can mean so much more for the patients and healthcare organizations by making healthcare more accessible and easier to navigate. 

Source: (PDF) The Value of Health Care Information Exchange and Interoperability (researchgate.net)

Semantic interoperability for better patient care 

What makes semantic interoperability for HIEs truly important is the fact that it facilitates the breaking of silos by improving the data exchange within the healthcare system. If health information can easily be exchanged and understood between HIEs and within HIEs and participating organizations, it will benefit the clinician and the patient by enabling safer care, more informed and easier decisions, better care coordination, less fragmentation, and cost savings.  

Errors and duplications would be minimized in the healthcare experience or ecosystem. In conclusion, semantic interoperability is extremely important to HIEs and electronic medical records (EMRs) since it is a huge factor in delivering enhanced societal, social (consumers’ welfare), and economical benefits. 

For further reading: 


  1. Semantic Interoperability in E-Health for Improved Healthcare | IntechOpen 
  1. (PDF) The Value of Health Care Information Exchange and Interoperability (researchgate.net) 

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